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Extrapyramidal reactions and the
selective serotonin-reuptake inhibitors.
Caley
CF.
School of Pharmacy, University of Connecticut, Hartford,
USA.
OBJECTIVE: To review the known published reports of
extrapyramidal reactions (EPRs) associated with the use of selective
serotonin-reuptake inhibitors (SSRIs). DATA SOURCES: Information was
selected from a MEDLINE search (January 1990 to January 1996) of
English-language medical literature. Manual searches of pertinent
journal article bibliographies were also performed. DATA EXTRACTION:
Appropriate information from all reports obtained was included, with
specific attention directed toward patient age, gender, primary
psychiatric diagnosis, total daily SSRI dosage, dosage escalation
strategy, and concurrent psychotropic medications. DATA SYNTHESIS:
Reports of EPRs associated with SSRI use have been accumulating in the
medical literature for several years. More commonly associated with
high-potency antipsychotics, EPRs can have an adverse impact on
medication compliance and hospital readmissions. The proposed hypothesis
for EPRs occurring with SSRI use involves serotonin's inhibitory actions
on extrapyramidal dopamine activity. Other possible contributing factors
include pharmacokinetic interactions or drug-disease interactions. EPRs
may include dystonias, dyskinesias, akathisia, parkinsonism,
exacerbations of Parkinson's disease, and possibly the neuroleptic
malignant syndrome. The majority of SSRI-related reactions appear to
occur within the first month of treatment. Information from available
case reports does not strongly support any consistent risk factor,
although some worth considering may include total SSRI daily dose, rapid
dose escalation strategies, increased age, female gender, concurrent
psychotropics known to also precipitate EPRs, and concurrent disease
states such as Parkinson's disease. Since SSRI-related EPRs have
occurred in different situations with different possible contributing
factors, clinical pharmacy practitioners and other healthcare providers
should remain aware of these reactions and carefully consider educating
and monitoring their patients accordingly. CONCLUSIONS: The use of SSRIs
may be associated with the development of EPRs; therefore, appropriate
monitoring should be considered for patients so that optimal
pharmaceutical care may be provided.
Publication Types:
PMID: 9416386 [PubMed - indexed for
MEDLINE]
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